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Hemorrhoid

life science Maturity 11-13 Next article →

Hemorrhoids are vascular structures located within the anal canal. In their healthy state, they function as essential cushions for stool control. These cushions are composed of connective tissue, smooth muscle, and specialized blood vessels called sinusoids. This network of vessels is known as the hemorrhoidal plexus.

Gross pathology of hemorrhoids
Gross pathology of hemorrhoids

When these structures become swollen or inflamed, the condition is referred to as hemorrhoids or piles. This is a very common issue. Approximately 50% to 66% of people experience hemorrhoid problems during their lives. They affect males and females with roughly equal frequency, most often between the ages of 45 and 65.

To understand how they work, we must look at the anatomy of the anal canal. There are three main cushions located at the left lateral, right anterior, and right posterior positions. These cushions contribute to 15% to 20% of anal closure pressure while at rest. They serve to protect the internal and external anal sphincter muscles during bowel movements. When a person bears down, intra-abdominal pressure increases. This pressure causes the cushions to expand in size. This expansion helps the body maintain anal closure during the process.

Haemorrhoiden 1Grad endo 01
Haemorrhoiden 1Grad endo 01

Hemorrhoids are categorized into two main types based on their location relative to the pectinate line. This line acts as a boundary within the anal canal. Internal hemorrhoids originate above the pectinate line. They are covered by columnar epithelium, which lacks pain receptors. Because of this, internal hemorrhoids often cause painless, bright red rectal bleeding. This blood may appear on the toilet paper or drip into the bowl.

Piles Grade 1
Piles Grade 1

External hemorrhoids occur below the pectinate line. They are covered by skin and anoderm, which are highly sensitive to temperature and pain. External hemorrhoids can cause swelling, itching, or significant pain if they become thrombosed. Thrombosis occurs when a blood clot forms within the vessel.

Perianal thrombosis 01
Perianal thrombosis 01

Doctors classify internal hemorrhoids into four distinct grades based on how much they prolapse. Grade I involves prominent blood vessels but no prolapse. Grade II occurs when the tissue prolapses during bearing down but returns on its own. Grade III requires manual reduction, meaning the person must push the tissue back in. Grade IV involves permanent prolapse that cannot be manually reduced.

Piles Grade 2
Piles Grade 2
Piles Grade 3
Piles Grade 3
Piles Grade 4
Piles Grade 4

These grades help medical professionals decide on the best course of action.

While the exact cause of symptomatic hemorrhoids remains unknown, several factors increase the risk. Most theories focus on things that increase intra-abdominal pressure. This includes constipation, diarrhea, and sitting on the toilet for long periods. Pregnancy is a significant factor because the fetus puts pressure on the abdomen. Hormonal changes and the process of childbirth also increase this pressure.

Hemrrhoids 04
Hemrrhoids 04

Other potential factors include obesity, a chronic cough, and a low-fiber diet. Some research also looks at genetics and pelvic floor dysfunction.

Diagnosis usually begins with a physical examination of the area. Doctors may use an anoscopy, which is a small tube with a light, to see internal hemorrhoids. In some cases, a colonoscopy or sigmoidoscopy is used to rule out more serious causes. Management often starts with conservative measures. These include increasing dietary fiber, drinking more fluids for hydration, and getting plenty of rest. Some people use nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain.

Hemrrhoids 05
Hemrrhoids 05

If conservative methods do not work, minor medical procedures may be necessary. Rubber band ligation is a common first-line treatment for grades I through III. A doctor applies an elastic band to the internal hemorrhoid to cut off its blood supply. Within five to seven days, the tissue withers and falls off. This procedure has an approximate cure rate of 87%. For more severe cases, surgery may be required. Hemorrhoidal artery embolization (HAE) is a newer, minimally invasive option that is often better tolerated than traditional surgery.

11th century English surgery
11th century English surgery
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🖼️ Images & Media (12)
File:M 44 anus 22.jpg
M 44 anus 22.jpg
File:Gross pathology of hemorrhoids.jpg
Gross pathology of hemorrhoids.jpg
File:Piles Grade 1.svg
Piles Grade 1.svg
File:Haemorrhoiden 1Grad endo 01.jpg
Haemorrhoiden 1Grad endo 01.jpg
File:Piles Grade 2.svg
Piles Grade 2.svg
File:Hemrrhoids 04.jpg
Hemrrhoids 04.jpg
File:Piles Grade 3.svg
Piles Grade 3.svg
File:Hemrrhoids 05.jpg
Hemrrhoids 05.jpg
File:Piles Grade 4.svg
Piles Grade 4.svg
File:Piles 4th deg 01.jpg
Piles 4th deg 01.jpg
File:Perianal thrombosis 01.jpg
Perianal thrombosis 01.jpg
File:11th century English surgery.jpg
11th century English surgery.jpg
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